Community participation for malaria elimination in Tafea Province, Vanuatu: Part I. Maintaining motivation for prevention practices in the context of disappearing disease.
Community participation for malaria elimination in Tafea Province, Vanuatu: Part I. Maintaining motivation for prevention practices in the context of disappearing disease.
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DOI：
10.1186/1475-2875-9-93
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发表时间：
2010-04-12
期刊：
影响因子：
3
通讯作者：
Vallely A
中科院分区：
文献类型：
--
作者：
Atkinson JA;Fitzgerald L;Toaliu H;Taleo G;Tynan A;Whittaker M;Riley I;Vallely A
在20世纪90年代，瓦努阿图Aneityum岛消灭疟疾的经验经常被作为在西南太平洋消灭疟疾的潜力的证据。然而，这一经验不能为代表更复杂的社会和环境情况的较大岛屿提供蓝图。社区支持是《Aneityum》成功的关键因素。在消除疾病、争取和保持社区参与塔菲亚省其他地区消除疟疾战略的背景下，瓦努阿图将面临更大的挑战。在Tanna岛的三个村庄进行了9次焦点小组讨论、12次关键信息者访谈、3次样带漫步和7次参与性讲习班，以调查社区对疟疾预防（特别是蚊帐）的看法和做法；对这些做法的影响，包括如何将疟疾纳入社区卫生和疾病优先事项；以及传递健康信息的有效途径。参与者确定的主要保护方法是使用蚊帐，然而，根据对疟疾存在的感知，研究村庄之间使用蚊帐的频率和动机有所不同。与会者认为，村庄、家庭和个人清洁对于预防疟疾很重要。对蚊帐使用的障碍和影响包括文化信仰和习俗、旅行、性别角色、蚊虫滋扰的季节性和对风险的认识。据报告，保健工作者和教会领袖对预防疟疾的做法影响最大。与会者更愿意通过访问社区卫生促进小组、卫生工作者、教会领袖和村长来获得卫生信息。在疟疾传播率低的环境中，增加社会资本和维持社区参与消除疟疾的一揽子计划将是必不可少的，包括：对影响疟疾预防和治疗的不断发展的当地社会文化、行为和实际问题进行定性监测的“哨点”；调动社会网络；跨部门协作;将疟疾干预措施与处理其他社区卫生和疾病优先事项的活动结合起来；有针对性地实施适合当地情况的多层次媒体运动，保持社区参与消除疟疾的动力。
In the 1990s, the experience of eliminating malaria from Aneityum Island, Vanuatu is often given as evidence for the potential to eliminate malaria in the south-west Pacific. This experience, however, cannot provide a blueprint for larger islands that represent more complex social and environmental contexts. Community support was a key contributor to success in Aneityum. In the context of disappearing disease, obtaining and maintaining community participation in strategies to eliminate malaria in the rest of Tafea Province, Vanuatu will be significantly more challenging. Nine focus group discussions (FGDs), 12 key informant interviews (KIIs), three transect walks and seven participatory workshops were carried out in three villages across Tanna Island to investigate community perceptions and practices relating to malaria prevention (particularly relating to bed nets); influences on these practices including how malaria is contextualized within community health and disease priorities; and effective avenues for channelling health information. The primary protection method identified by participants was the use of bed nets, however, the frequency and motivation for their use differed between study villages on the basis of the perceived presence of malaria. Village, household and personal cleanliness were identified by participants as important for protection against malaria. Barriers and influences on bed net use included cultural beliefs and practices, travel, gender roles, seasonality of mosquito nuisance and risk perception. Health care workers and church leaders were reported to have greatest influence on malaria prevention practices. Participants preferred receiving health information through visiting community health promotion teams, health workers, church leaders and village chiefs. In low malaria transmission settings, a package for augmenting social capital and sustaining community participation for elimination will be essential and includes: 'sentinel sites' for qualitative monitoring of evolving local socio-cultural, behavioural and practical issues that impact malaria prevention and treatment; mobilizing social networks; intersectoral collaboration; integration of malaria interventions with activities addressing other community health and disease priorities; and targeted implementation of locally appropriate, multi-level, media campaigns that sustain motivation for community participation in malaria elimination.
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